tbuckley/cabot-search huggingface dataset:
Abstract 13813: Novel Noncoding Y RNA Drug Attenuates Fibrosis and Diastolic Dysfunction in Systemic Sclerosis
Authors: Xaviar M Jones, Alessandra Ciullo, Thassio Mesquita, Liang Li, Mario Fournier, Weixin Liu, Ahmed G Ibrahim, Eduardo Marban
Journal: Circulation (2022)

Introduction: Scleroderma is an autoimmune disease characterized by early vasculopathy, and fibrosis of the skin, heart and lung, resulting in irreversible scarring and organ failure. Current therapy only mitigates symptoms with no available curative options. We have previously demonstrated anti fibrotic and anti-inflammatory properties of EV-YF1, a small Y RNA abundant in extracellular vesicles secreted by cardiosphere-derived cells. Here we describe the therapeutic bioactivity of a shorter, engineered derivative, TY4. Methods: TY4, a 24-nucleotide chemically-modified oligonucleotide bioinspired by EV-YF1, was synthesized and packaged into lipid nanoparticles. To create a model of systemic sclerosis, C57BL/6J wild type mice (n=100 total) were injected with 100 μL bleomycin or PBS (control) subcutaneously every other day for 3 weeks. Animals then received either vehicle (0.9% NaCl), TY4 scrambled (as an RNA control) or TY4 via oral gavage. Endpoints include body weight, exercise capacity, echocardiography, and histologic quantification of fibrosis in heart and skin. Results: At study endpoint, animals receiving TY4 demonstrated body weight recovery (p&lt;0.0001) and augmented exercise capacity (p&lt;0.0002) compared to vehicle and TY4 scrambled. Similarly, cardiac fibrosis (p&lt;0.0001) and dermal thickness (TY4 287 ± 45 μm, TY4 scrambled 426 ±75 μm , vehicle 419 ±116 μm p&lt;0.0001) were largely normalized after TY4 administration. Diastolic dysfunction, as measured by echocardiography (E/E’), was present in controls but reverted to normal after TY4 administration (p&lt;0.0001). Conclusions: These results demonstrate the therapeutic bioactivity of a bioinspired new chemical entity with the potential to become a synthetic, off-the-shelf drug for systemic sclerosis.
Abstract 13360: Impact of Goal Setting in a Digital Health Coaching Program for Participants With Type 2 Diabetes
Authors: Jasmine Moore, Dhiren Patel, Vanessia Tran, B Stephen Burton
Journal: Circulation (2022)

Introduction: Cardiovascular disease remains one of the most common causes of death in people with diabetes. We retrospectively explored how a digital health coaching (DHC) program with goal-driven engagement for individuals with type 2 diabetes mellitus (T2DM) influenced outcomes at 3 months. Methods: This retrospective analysis included de-identified results from overweight/obese individuals who participated in a 3-month DHC program tailored for people with diabetes, whose main goal was medication adherence. Participants were referred through employer programs, payor programs, or physicians. Changes in biometric variables and diabetes-related quality of life were assessed at 3 months. Results: Over one year (January 1, 2021, to December 31, 2021), 182 participants engaged and completed the DHC program. Participants were predominantly women (79%), with an average age of 50, and racially/ethnically diverse (51% white, 49% non-white). Of this cohort, 24% lived in rural areas, and 44 participants had low medication adherence scores at baseline. At 3 months, there were significant decreases in diabetes distress score (27.14% reduction in diabetes distress; 2.91 to 2.12, p&lt;0.001) and HbA1c (6.44% improvement; 7.61 to 7.12, p-0.0017). In addition, members with low medication adherence scores had a larger improvement than all members, with the main cohort improving the medication adherence score by 5.4% (10.34 to 10.90, p=0.058) and the low medication adherence group improving by 18.07% (7.55 to 8.91, p=0.007). Members with low medication adherence scores at baseline had significantly larger improvement than all other members, with 12.67% more improvement than members overall. Conclusions: Participants in the program showed improved outcomes for HbA1c and diabetes-related quality of life measures at 3 months. Engaging patients in DHC can help improve outcomes in populations at-risk of low adherence.
Abstract 14140: Efficacy of Coronary Intravascular Lithotripsy Therapy on Severely Calcified Coronary Stenoses
Authors: Kartik P Jadhav, srinivasa r maddury, Narasaraju Kavalipati, Kapil Challawar, Kondalrao Gollamandala, Syed Akram Ali
Journal: Circulation (2022)

Introduction: Intravascular lithotripsy (IVL) is rapidly proving its effectiveness in modifying calcific coronaries. IVL causes cracks in calcium with acoustic waves Fig1 (A-D). Hypothesis: IVL is effective in calcific coronary artery modification. Methods: Study aims to assess the effectiveness in calcific coronary artery modification. This study is a prospective, single arm single center study designed to assess the effectiveness of the IVL. The primary endpoint is to determine the extent of procedural success. The calcium modification is assessed by optical coherence tomography (OCT). Based on OCT imaging the percentage of stent expansion after IVL was categorized into ‘Optimal’ and ‘Suboptimal’ and ‘Subpar’ outcomes. Results: Patients (n:26; M:17; F:9) were enrolled in last 6 months. IVL was used in 22 LAD (84.6%) and 4 RCA (15.4%). Mean calcified segment length was 33.8 mm, mean angle of calcium arc was 202.3 degrees and superficial calcific lesions were 5 out of 26 (19.2%). OCT demonstrated multiplane and longitudinal calcium fractures after IVL in all (100%) lesions. There were no subpar outcomes among our cohort. 19 patients (73%) had optimal outcomes and 7 (27%) had suboptimal but acceptable outcomes. Final in-stent gain in diameter at maximum stenotic area was 1.83±0.67mm. Out of 7 patients with sub-optimal (80-95%) stent expansion, 5 patients were found to have superficial calcific lesion. Similarly, out of 20 deep calcific lesions only 2 patients had sub-optimal stent expansion. Conclusions: IVL typically causes circumferential calcium fractures in several planes like circumferential, transmural planes, and thus seldom results in uniplanar "troughs" arising with atherectomy technologies due to guidewire bias. Procedural success achieved in 100% in our cohort. Superficial calcific lesions had strong association with sub-optimal stent expansion outcome (p: 0.000383). IVL is proving to be a valuable tool in dealing with coronary calcification.
Abstract 12917: Reproducibility of Use by Physicians and Patients of a Smart Stethoscope for Artificial-Intelligence Enhanced Diagnosis of Heart Failure
Authors: Akila Wickramathilaka, Mihir A Kelshiker, Jake Griffin, Manisha Gandhi, Camille F Petri, Melanie T Almonte, Patrik Bachtiger, Nicholas S Peters
Journal: Circulation (2022)

Introduction: Early detection of heart failure (HF) is a global health system priority. An artificial intelligence-enhanced stethoscope (‘Eko DUO’), is capable of recording and analysing a single-lead ECG to detect HF with reduced left ventricular ejection fraction (LVEF≤40%) after only 15 seconds of apposition to the chest. Given this simplicity, patient-administered remote HF diagnosis and screening is feasible if performance and reproducibility of use of the Eko DUO is adequate. Hypothesis: We tested hypotheses that: 1. Eko DUO predictions for LVEF≤40% have good intra- and inter- operator reproducibility (intra-class correlation coefficient &gt; 0.75) for both patient and clinician deployment. 2. Eko DUO performance for detection of LVEF≤40% is comparable between patients and clinicians Methods: 98 hospital inpatients undergoing echocardiography at Imperial College Healthcare NHS Trust, UK, performed self-examination with the Eko DUO, using instructions to take three recordings from the left parasternal 2nd intercostal position. A clinician then repeated three recordings. The intra-class correlation coefficient was calculated using the raw numerical artificial intelligence predictions for LVEF≤40%. Performance for detection of LVEF≤40% was measured by calculating the area under the receiver-operating characteristic curves (AUC) using a reference standard of echocardiography-derived percentage LVEF. Results: There was good intra-operator reproducibility for both patients (ICC = 0.817) and for clinicians (ICC = 0.888), and good inter-operator reproducibility between patient and clinicians (ICC = 0.887). The performance of the Eko DUO was comparable between patients and clinicians (AUC = 0.887 vs. AUC = 0.800, respectively). Conclusions: The Eko DUO predictions for LVEF≤40% have good intra- and inter-operator reproducibility between patients and clinicians.
Abstract 12871: Left Atrial Appendage Occlusion in Patients With Atrial Fibrillation and Hypertrophic Cardiomyopathy
Authors: Tasveer Khawaja, Monil Majmundar, ZACHARY ZUZEK, Shilpkumar Arora, Anene C Ukaigwe
Journal: Circulation (2022)

Introduction: Patients with hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF) are at increased stroke risk in comparison to those without HCM. The role of left atrial appendage occlusion (LAAO) in these patients is unclear. Methods: In this retrospective cohort study, we identified patients with HCM and AF using the National Readmission Dataset from 2016-19. Patients were stratified based on LAAO status. The primary efficacy outcome was a composite of any stroke (ischemic and hemorrhagic), TIA, and all-cause mortality. The primary safety outcome was a composite of major bleeding and pericardial complications. Individual components of the primary outcomes were secondary outcomes. Patients were matched using inverse probability of treatment weighting. Cox-proportional hazard regression was applied to calculate hazard ratio (HR) with 95% confidence interval (CI) on matched cohorts. Results: We identified 71,980 patients with HCM and AF. Of these, 1,351 (1.9%) patients underwent LAAO. Those who underwent LAAO were significantly younger than those who did not (67.5±10.1 years vs. 70.0±13.1 years, p&lt;0.001) and were more likely to be male (54.6% vs. 45.4%). LAAO was associated with a lower risk of the primary efficacy outcome (2.5% vs. 5.4%, HR: 0.38; 95% CI: 0.17-0.88; p=0.024) and the primary safety outcome (2.9% vs. 6.8%, HR: 0.39; 95% CI: 0.23-0.66, p=0.001). LAAO associated with reduced major bleeding (1.6% vs. 6.0%, HR 0.34, 95% CI 0.18-0.64, p=0.001), GI bleeding (0.2% vs. 1.3%, HR 0.22; 95% CI: 0.06-0.79, p=0.02), blood transfusions requiring admission (2.10% vs. 4.90%, HR 0.37, 95% CI 0.19-0.73, p=0.004), and admissions for bleeding (0.50% vs. 2.30%, HR 0.20, 95% CI 0.07-0.58, p=0.003). Pericardial complications were similar in both groups. Conclusion: LAAO was associated with a lower risk of stroke and major bleeding in patients with HCM and AF. Future prospective studies on the safety and efficacy of LAAO in concurrent AF and HCM are needed.
Abstract 13156: The Location of Combined High-Risk Low Endothelial Shear Stress and High Plaque Structural Stress is Distant From the Minimal Lumen Area in the Majority of Coronary Plaques Responsible for Major Adverse Cardiac Events
Authors: Mona Ahmed, Sophie Z Gu, Diaa Hakim, Ahmet U Coskun, Nicholas Cefalo, Yuan Huang, Charles Maynard, Charis Costopoulos, Akiko Maehara, Gregg W Stone, Martin R Bennett, Peter H Stone
Journal: Circulation (2022)

Introduction: The presence of multiple high-risk prognostic features enhances risk-stratification of plaques prone to destabilization and major adverse cardiac events (MACE). Spatial superimposition of high-risk features (concordance) likely amplifies local risk. Local endothelial shear stress (ESS) and plaque structural stress (PSS) metrics predict MACE, but their spatial concordance and their location relative to the minimal lumen area (MLA) is unknown. If the highest-risk plaque area is distant from the MLA, then PCI of the MLA alone will leave high-risk plaque areas untreated. Purpose: To identify the site of high-risk features of low ESS and high PSS heterogeneity (HI) along the course of a plaque in patients who develop MACE, and the site of their spatial concordance relative to the MLA. Methods: We examined ESS, PSS, and PSS HI in 22 non-culprit lesions (NCL) leading to MACE, and 64 randomly selected control NCLs without MACE from the PROSPECT study. ESS was calculated by computational fluid dynamics and PSS by finite element analysis on co-registered lesions. We examined high-risk plaques with empirically-derived (ROC curve) ESS &lt; 1.3 Pa and PSS HI &gt; 0.29 in 16 lesions leading to future MACE, and 11 control lesions without MACE. Results: MACE outcomes were significantly more frequent in plaques with combined low ESS+high PSS HI vs plaques with low ESS alone (72.7% vs 27.3%, p&lt;0.001) at 3 years follow-up. Of the 16 MACE plaques with both low ESS+high PSS HI, 14 exhibited high-risk values that were spatially concordant vs 2 that were discordant (87.5% v 12.5%, p=0.01). In the 14 plaques with concordant values, there were 26 focal plaque areas with high-risk concordance. The mean distance from the concordant high-risk areas to the MLA was 13.2 ± 11.6 mm (Figure). Conclusion: High-risk ESS and PSS measures frequently co-localize in plaques responsible for future MACE, and are substantially distant from the MLA. PCI of the MLA area alone may leave many high-risk areas untreated.
Abstract 13762: Does Social Disadvantage Modify the Association Between Health Rating and Disruption Due to COVID-19 Among Adults With Hypertension
Authors: Onoriode Kesiena, Aysha Allahverdiyeva, Mehdi Rizvi, Jacob Braunstein, Kobina Hagan, Navin Kumar, Shreyas Singireddy, Kofi D Seffah, Temitope Olokunlade, Reed Mszar, Elias Mossialos, Garima Sharma, Khurram Nasir
Journal: Circulation (2022)

Introduction: The COVID-19 pandemic disrupted health care across diverse populations with negative outcomes. We evaluated the relationship between health rating, cumulative social risk (CSR), and disruption in health care due to COVID-19 among adults with hypertension. Methods: Data of 11,494 adults with hypertension from the 2020 National Health Interview Survey was used. Respondents with hypertension rated their health as fair/poor, good, or very good/excellent. Disruption in care was either delayed healthcare or not getting care due to COVID-19. CSR was a composite of economic stability, education, food insecurity, health care system, and physical environment grouped into quartiles, with the highest quartile representing the least social risk. Multiple logistic regression was used in the analysis. Results: The mean (SE) age was 60.1 (0.22) years, with 50.5% females. A fair/poor health rating and being in CSR quartile 2 [AOR 0.40 (0.19, 0.86), p=0.019] or CSR quartile 3 [AOR 0.42 (1.20, 0.91), p-0.028] were more likely to get care due to COVID-19 when compared to the CSR quartile 4. A similar relationship was seen in those who rated their health as good and belonged to CSR quartile 2 [AOR 0.49 (0.28, 0.87), p=0.015] or CSR quartile 3 [AOR 0.59 (0.35, 0.98), p=0.043]. Delaying medical care due to COVID-19 was increasingly less likely for those who rated their health as good and belonged to CSR quartile 1 [AOR 0.41 (0.17, 0.99), p=0.049], quartile 2 [AOR 0.43 (0.27, 0.67) p&lt;0.001], and quartile 3 [ AOR 0.57 (0.36, 0.89), p=0.013] as compared to those in quartile 4. Conclusions: Individuals with hypertension and a poor to good health rating were less likely to delay or not get medical care due to COVID-19, with an average to high social risk being related to this increase likelihood.
Abstract 14166: Predictors of Mortality in Patients With In-Hospital STEMI After Implementation of a Comprehensive STEMI Protocol
Authors: Christopher Kanaan, Nicholas Kassis, Raunak Nair, Anirudh Kumar, Grant W Reed, Amar Krishnaswamy, Venu Menon, A M Lincoff, Samir R Kapadia, Umesh N Khot
Journal: Circulation (2022)

Introduction Patients who experience in-hospital ST-elevation myocardial infarction (iSTEMI) comprise a uniquely high-risk cohort owing to multiple factors including delays in diagnosis and treatment. Improvements in quality care metrics are needed to more fully understand the reasons for the poor outcomes, including high mortality, in this population. Methods Consecutive patients with iSTEMI who were treated with percutaneous coronary intervention (PCI) between 01/01/2011-07/15/2019 at a single, tertiary referral center were included. A comprehensive iSTEMI protocol (CSP) was implemented on 7/15/2014, incorporating: (1) nursing chest pain protocol, (2) improved electronic access to electrocardiographic studies, (3) checklist for initial triage and management, (4) 24/7/365 catheterization lab readiness, and (5) radial-first PCI approach. Process metrics and clinical outcomes were compared pre- and post-CSP implementation, and multivariable logistic regression analysis was performed to assess for predictors of in-hospital mortality. Results Among 125 iSTEMI patients, the post-CSP group (n=81) were younger with more active smoking and heart failure relative to the pre-CSP group (n=44). CSP implementation resulted in an increased use of trans-radial PCI (14.6 vs. 70.4%, p&lt;0.001), greater rate of ECG-to-first device activation &lt; 90 minutes (36.4% vs. 76.5%, p&lt;0.001), and decreased median ECG-to-first device activation time (114 vs. 64 minutes, p&lt;0.001). In-hospital mortality was numerically lower in the post-CSP group (18.2% vs. 9.9%, p=0.295). On multivariable analysis, the presence of shock was the only independent predictor of in-hospital mortality (OR: 26.05, 95% CI [5.5-211.6], p&lt;0.001). Conclusions The adoption of a CSP conferred marked improvements in key care metrics in patients with iSTEMI. Its use holds promise in reducing mortality among a vulnerable population at high risk of death owing to underlying shock.
Abstract 13240: The Relationship Between History of Valve Surgery and Heart Failure Event in Japanese Atrial Fibrillation Patients: The Fushimi Af Registry
Authors: KOSUKE DOI, Kenjiro Ishigami, Syuhei Ikeda, Takashi Yoshizawa, Yasuhiro Hamatani, Yuya Ide, Akiko Fujino, Mitsuru Ishii, Moritake Iguchi, Hisashi Ogawa, Nobutoyo Masunaga, Hiromichi Wada, Koji Hasegawa, Mitsuru Abe, Masaharu Akao
Journal: Circulation (2022)

Background: We previously reported that valvular heart disease (VHD) was associated with an increased risk of hospitalization for heart failure (HF) in Japanese atrial fibrillation (AF) patients. However, the association of history of surgery for VHD with HF hospitalization remains unknown. Method: The Fushimi AF Registry is a community-based prospective survey of AF patients in Fushimi-ku, Kyoto, which is a typical urban district of Japan. We started to enroll patients from March 2011, and follow-up data were available for 4,489 patients by the end of July 2021. In the entire cohort, 747 patients had VHD. We divided them to surgery group (n=182) and non-surgery group (n=565). We compared clinical characteristics and incidence rates of HF hospitalization between two groups. Result: Patients who received valve surgery were younger (72.0 years vs. 78.0 years, p&amp;lt;0.001), had lower systolic blood pressure (118 mmHg vs. 123 mmHg, p=0.02) and pulse rate (75.5 bpm vs. 79.1 bpm, p=0.003), more often paroxysmal type (46.7% vs. 31.0%, p&amp;lt;0.001), less likely to have hypertension (51.1% vs. 66.2%, p&amp;lt;0.001) and had lower CHADS2 score (2.09 vs. 2.55, p&amp;lt;0.001) than non-surgery group. Body weight, sex, prior HF, chronic kidney disease and prescription data were comparable between two groups. During the median follow-up of 1,679 days, the incidence rate of HF hospitalization was lower in surgery group than non-surgery group (2.58% vs. 4.43% per person-year, respectively, log rank p=0.001). On multivariate Cox regression analysis, history of surgery was not significantly associated with a lower risk of HF hospitalization (adjusted hazard ratio 0.76; 95% confidence interval 0.52-1.12, p=0.16). Conclusion: The incidence rate of HF hospitalization was lower in patients with valve surgery than non-surgery group. However, history of valve surgery was not independently associated with a lower risk of HF hospitalization in Japanese AF patients.
Abstract 12931: Contemporary Trends of Subcutaneous Implantable Cardioverter Defibrillator Utilization in the United States: Insights From the National Inpatient Sample 2016-2019
Authors: Islam Shatla, Mahmoud El Iskandarani, kevin kennedy, Alan P Wimmer
Journal: Circulation (2022)

Introduction: The subcutaneous implantable cardioverter defibrillator (S-ICD) has emerged as an alternative to the transvenous ICD with comparable efficacy and complication rates in clinical trials. Adoption of this technology and real-world clinical experience are less well described. Methods: This was a retrospective descriptive cohort study using data from National Inpatient Sample (NIS) for calendar years 2016-2019. Outcomes were cardiovascular adverse events, all-cause mortality, 30-day readmission, and resource utilization in patients who had S-ICD implantation. Results: We identified 6655 patients who had S-ICD implantation between 2016-2019. S-ICD implant rates remained between 10-12% of total ICD implants in the US over the study period (Figure 1a), though hospital implant rates were widely distributed (Figure 1b). The mean (SD) age of the population was 56.1 ± 15.9 years, and 2002 patients (30.1%) were female. Median length of stay (IQR) was 6.0 (4.0, 10.0). Hospitalization costs were $ 245937.1 ± 206047.3. Adverse cardiovascular events associated with the hospitalization were: pericardial perforation/cardiac tamponade (0.2%), hemothorax/pneumothorax (1.1%), stroke/TIA (0.5%), cardiogenic shock (8.6%), cardiac arrest (11%), and vascular complications (1.3%). A total of 48 patients (0.7%) died. Non-elective readmission within 30 days post-procedure occurred in 15.7% of cases. Conclusion: S-ICD implant rates were stable over time but varied widely among hospitals. Hospitalization-associated adverse cardiovascular events may be more a reflection of the vulnerable population undergoing S-ICD implant than risk of the procedure.